Surgical Treatment of Cerebellar Metastases: Survival Benefits, Complications and Timing Issues

We retrospectively studied 73 consecutive patients who underwent surgery 2015–2020 for removal of cerebellar metastases (CM). Median overall survival (medOS) varied widely between patients and compared favorably with the more recent literature (9.2, 25–75% IQR: 3.2–21.7 months vs. 5–8 months). Prognostic factors included clinical (but not radiological) hydrocephalus (medOS 11.3 vs. 5.2 months, p = 0.0374). Of note, a third of the patients with a KPI <70% or multiple metastases survived >12 months. Chemotherapy played a prominent prognostic role (medOS 15.5 vs. 2.3, p < 0.0001) possibly reflecting advances in treating systemic vis-à-vis controlled CNS disease. Major neurological (≥30 days), surgical and medical complications (CTCAE III–V) were observed in 8.2%, 13.7%, and 9.6%, respectively. The occurrence of a major complication markedly reduced survival (10.7 vs. 2.5 months, p = 0.020). The presence of extracerebral metastases did not significantly influence OS. Postponing staging was not associated with more complications or shorter survival. Together these data argue for individualized decision making which includes offering surgery in selected cases with a presumably adverse prognosis and also occasional urgent operations in cases without a preoperative oncological work-up. Complication avoidance is of utmost importance.

Carcinoma cervix with cerebellar metastases presenting with pulmonary aspiration: a rare presentation and a rare metastatic site in a common cancer

A 52-year-old woman with cervical cancer stage IIB presented with altered sensorium and breathlessness to the emergency room 5 months after completing primary chemoradiotherapy, which was diagnosed as aspiration pneumonia. She was found to have cerebellar metastases with additional frontal, occipital, and temporal lobe lesions. She had no evidence of extracranial disease. She received supportive care and palliative whole brain radiotherapy and was asymptomatic at 6 months following radiotherapy. Median reported survival is 8–13 months.

Cerebellar metastases as the only brain metastatic site and correlation with molecular characteristics of primary breast cancer.

e12509 Background: Contrary to well recognized higher incidence of brain metastases (BM) in HER2 3+ and triple negative (TN) BC, correlation with BC molecular subtypes and cerebellar metastases is not well explored. Methods: From January 2007 to Jun 2016, 269 patients with BCBM have been prospectively registered at the Institute for Oncology and Radiology of Serbia. We analyzed metastases localization within brain, and identified 28 patients with cerebellar metastases. Correlation with molecular subtype of primary BC, median time to cerebellar metastases development, treatment and survival were also analyzed Results: 28 patients (10.4%) of median 47 years (29-63) had cerebellar metastases as the only brain metastatic site confirmed by CT/MRI. Median time to cerebellar BM was 21 months (range 0-141). Cerebellum was the first distant metastatic site in 20/28 patients (71.4%), and 8 (28. 5%) patients had inoperable BC and/or distant metastases before cerebellar metastases development. Molecular subtype of primary BC was known for 27/28 pts (96.4%): 21 pts (77.7%) had HER2 3+BC; 14 (52%) had ER/PR negative BC and there were no TNBC. Fifteen patients (53.5%) were treated with brain surgery + postoperative WBRT, 4 (14%) with gamma knife, while remaining 9 pts (32%) underwent WBRT only. Patients with good performance (PS 0-2) also received various systemic treatments +/- trastuzumab/ lapatinib. Mean survival upon cerebellar metastases was 19.2 months (median 9, range 2-123+ months); 39% patients were alive after 12 months; 21% after 24 months; 14% after 36 months. One patient (3.6%) is alive without relapse/progression 123 months+ after cerebellar metastases extirpation; trastuzumab is ongoing through all that period. Conclusions: Majority of analyzed patients with cerebellar metastases had HER2 3+ BC (77.7%). It is also interesting that none of patients within this group had TNBC Therefore, it seems reasonable to speculate that some still unrecognized BC and/or cerebellar soil characteristic, contribute to HER2 3+ BC predilection to cerebellum in this rare patient subgroup.

A Rare Clinical Presentation of Cholangiocarcinoma

Cholangiocarcinoma is an uncommon tumor, often diagnosed in the context of obstructive jaundice. Brain metastasis rarely occurs with the cerebellum being a rare site of spread of this type of tumor. Few cases of cholangiocarcinoma have been reported in the literature and this type of tumor is associated with a very poor outcome. We present a very rare form of clinical presentation of cholangiocarcinoma with neurologic symptoms due to cerebellar metastases.

Advanced Small Cell Lung Cancer with Cerebellar Metastases – A Case Report

Background: Small cell lung cancer is an aggressive subtype of lung cancer whereby about one-third of cases are complicated with brain metastases. However, cerebellar metastases are uncommon and contribute to less than 10% of brain metastases. Case: We report a 76-year-old Malay male, an active smoker who presented with dyspnea and occasional cough with hemoptysis for one week. He also presented with headache and constitutional symptoms of malignancy. Clinical examination suggested the presence of right upper chest pathology and positive left cerebellar signs. His condition deteriorated two days later and he passed away after failed attempts at resuscitation. Chest radiograph showed right upper lobe collapse, and brain magnetic resonance imaging showed metastatic lesion in the left cerebellum extending to the right cerebellum. Post-mortem findings revealed small cell lung cancer with cerebellar metastases. Conclusion: Small cell lung cancer patients with brain metastases deteriorate very rapidly, and the management is mainly supportive. Primary prevention through education is the best way to reduce the incidence of lung cancer. In addition, secondary prevention and screening should be undertaken at earlier stages of the disease, as some studies have shown that combined chemotherapy and radiotherapy improve prognosis of malignancies detected at early stage